Chronic condition, health insurance, small company?

April 17, 2006 1:57 PM

If someone has a chronic health condition, and accepts a job at a small U.S. company, how likely is it that health insurance premiums will go up for employees at that company?
posted by anonymous to work & money (6 comments total)

Depends on how small the company is, and on the type of insurance that company uses, and on how much the employer pays, and on how much the employer passes on increases to its employees.

Bottom line answer: take the job. Let the employer deal with the cost of insurance. They may decide to decrease benefits, raise their cost to employees, or eliminate them altogether. This is not a decision one should hoist upon oneself.
posted by deadfather at 2:08 PM on April 17, 2006

Not enough information. In some states insurers are mandated to offer small employers (often under 15,20,25,50,etc.) group plans at what are called community rating. In those cases an individual's claim does not effect the rating. Larger employers are usually rated based on experience which means claims will effect the premiums of all subscribers in that plan. However, this varies from state to state and insurer to insurer so with out knowing the specifics it is difficult to answer your question. Also, it depends on the chronic disease--well managed hypertension is not nearly the problem of (say) unmanaged asthma or unmanged diabetes.
posted by rmhsinc at 2:09 PM on April 17, 2006

My apologies for extending my answer to a nonexistent question. I should say: it is likely but not certain to increase, but to determine how much, considerable more information is needed.
posted by deadfather at 2:11 PM on April 17, 2006

Anon - it really depends on the state. E-mail me for more.
posted by bh at 2:18 PM on April 17, 2006

I worked at a company with a few thousand employees in the US. After several years of working there, my wife and I started taking advantage of a benefit that was both very, very expensive and virtually unregulated -- that is, there was no lifetime maximum and the number of occurances was quite high.

After two years of taking advantage of this benefit, the insurance renewal came around -- and lo and behold, that specific procedure was suddenly limited to a lifetime maximum that would barely cover one occurance.

So perhaps the answer is "it might, or it might be possible for the company to keep the same premium cost by eliminating or reducing coverage for that specific ailment." Presumably, though, it would happen at renewal time (renewal with the insurance company, not necessarily the yearly employee renewal.)
posted by davejay at 2:34 PM on April 17, 2006

This was asked previously here and here. The general consensus was that it varies by state as bh said. I'll repost my answer from one thread that referenced this Guide to Health Insurance Options for Small Businesses PDF document.
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On page 8, "What if an Employee or Dependent has a pre-existing medical condition?" is asked. The answer is yes, a pre-existing condition can push premiums by up to 25% in many states (termed medical underwriting). Some states don't permit plans to increase premiums based on health status (NY, MA, WA) while others have no caps on premium increases (VA, PA).

Texas is given as an example with a fictional company: if the firm was newly buying insurance, the premium rate-up could be as high as 67% but if the company was adding a member to an existing plan, the state caps the rate-up at 15%.
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Irregardless, you should take the job as deadfeather said and let the company worry about the health insurance ramifications.
posted by junesix at 3:05 PM on April 17, 2006